Ealing Standard Update

Tessa Sandall

Appendix 1

The Ealing Standard - Background• Ealing standard (ES) is a primary care wrap-around contract for 3 ½ years

from 1st October 2017 covering 23 standards and was approved by ECCG Governing Body in July 2017

• All 75 Practices have signed the contract• Contract started with the Access standard on 1st October 2017, the

remaining 22 standards began from 1st April 2018 • ES looks to ensure equity in clinical quality and provision of service to all

Ealing registered patients • Development and delivery of all 23 standards has been clinically led with

lead clinicians assigned to each Standard• Community Education Provider Network (CEPN) programme is fully

aligned to the ES, providing education, training and developing workshops for practices

Principles• ES provides some services historically provided in a hospital setting in the

primary care setting. It reduces the burden on secondary care, moving certain types of care closer to the patient. In doing so reducing waiting times for patients for certain diagnostic tests and outpatients, and ensuring patients are seen in the most appropriate setting

• All practices ensure access to all the services under ES. Practices either provide the service themselves or refer to neighbouring practices under the Ealing inter-practice referrals process.

• There is a patient experience standard and ES is often discussed at the ECCG Patient Engagement Reference Forum (PERF)

Access• Access standard looks to address issues of capacity and accessibility for

patient to GP Practice appointments• It sets a minimum threshold of 100 clinical consultations per 1000

population per week. Currently practices across Ealing are offering an average of 135 (as at Jan 2019). Previous to the ES, this was un-reportable.

• Extended access hubs ensure patients can be seen seven days a week between 8am and 8pm, with 3 sites across the borough to ensure population coverage

• Has supported increased capacity and allows patients to be seen in primary care, reducing the level of burden on the urgent and emergency care system

• Healthwatch produce a quarterly patient experience report and there has been demonstrated improvement with a reduction in negative comments although still report that getting through on the phone, getting an appointment and waiting times are the issues patients still view as needing improvement

Access Dashboard

Benefits and successes of the Ealing Standard• All 75 Practices signed the Ealing Standard contract• There have been almost 9,000 ECGs (as at Dec 2018) undertaken in

primary care often avoiding a visit to hospital• Woundcare is provided with almost 26,000 appointments (as at Dec

2018) delivered in primary care. Previously, patients reported significant problems with getting access to Wound Care services in the community. There has been a notable reduction in issues being reported.

• In Diabetes, there has been significant improvement in ensuring patients receive their 9 key care processes, supporting self care and in doing so giving patients the best chance to reduce complications

• Other significant services are provided in the community under the Ealing Standard, which were historically provided in secondary care, providing care closer to the patient at a reduced cost, e.g. Ambulatory Blood Pressure Monitoring (ABPM) or taking blood tests

Benefits and successes of the Ealing Standard• ES has supported reducing the burden on the urgent and emergency care

system by increasing access in primary care and therefore reducing UCC and A&E attendances

• Practices have reported recruitment of various roles including clinical pharmacists and other healthcare professionals as there is a commitment to funding under the Ealing Standard, therefore improving access and providing a multi-disciplinary approach

• Practices have reported that there are more appointments offered than booked – although this will vary from practice to practice

• Other standards have significantly reduced the number of emergency admissions, with almost 200 fewer (as at Jan 2019) emergency admissions in Asthma, COPD, Diabetes and End of life care

• Patient experience standard produces analysis and a dashboard linked to the GP National survey to support practices to look at trends and areas to improve and support patient engagement

• ES KPI dashboard has been developed to support practices with monthly performance data and ensure delivery of the contract

Ealing Standard Dashboard

19/20 next steps• Clinically led refresh of all standards is underway• Evaluation of 18/19 performance, feedback and outcomes• ES supports greater collaborative working across practices with inter-

practice referrals and some elements of certain standards having to be delivered across a network

• ECCG works closely with it’s practices, with appointed clinical leads and CCG management leads being linked to work directly with one of the 7 networks

• Although, there is no longer a formal tripartite agreement, ECCG continues to work closely with Ealing GP Ltd (Federation). Ealing GP Ltd provide support directly to practices that have subscribed to the services from the Federation

• ES is crucial to the delivery of primary care transformation, and supporting the development of primary care networks, now mandated within the new GP contract.

• Primary care networks as the foundation forIntegrated Care Systems

• Preventing ill health and tackling health inequalities

• Supporting the workforce

• Maximising opportunities presented by dataand technology

New GP Contract

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Practices continue to provide core servicesNetwork Contract DES provides practices opportunity to work collaboratively with other practices health, social care and voluntary partners to deliver services Practices and other health, social care and voluntary partners collaborate as primary care networks, providing additional services that can’t be delivered on a smaller scale

Place c.250-500k OR

Integrated Care Partnership (ICP)

• Primary care interacts with hospitals, mental health trusts, local authorities and community providers to plan and deliver integrated care

• In some systems, federations support efficiencies of scale and provide a voice for primary care

• Primary care participates as an equal partner in decision making on strategy and resource allocation

• Action is taken to ensure collaboration across hospitals, communityservices, social care and other partners, helping to join up and improve care

• Data is used to deploy resources where they can have the maximum impact

• Each person can access joined up, proactive and personalised care, based on ‘what matters’ to them and their individual strengths, needs and preferences

Neighbourhood c.30k~50k

OR Primary Care Network (PCN)

System c.1+m OR Integrated

Care System (ICS)

Individual

How will that look within a local system?

• Primary Care Networks (PCNs) are an essential building block of Integrated Care Systems.

• A new Network Contract – this is a Directed Enhanced Service (DES)backed by financial entitlements.

• PCNs will cover a typical population of 30-50,000 – we expect 100% geographical coverageby July 2019.

• All PCNs will have a Network Agreement. A national template version will be mandated to reduce avoidable legal and transaction costs. The Network Agreement is both the means by which the PCN sets out its collective rights and obligations, as well as how it will partner with non-GP practice stakeholders.

• Every Integrated Care System will have a critical role in ensuring that PCNs work in an integrated way with other community staff such as community nurses, community geriatricians, dementia workers, and podiatrists/chiropodists.

• A new PCN development programme will be centrally funded and delivered throughIntegrated Care Systems.

Primary Care Networks

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The new GP Contract will deliver the biggest boost to primary care since 2004. Through a new Additional Roles Reimbursement Scheme, PCNs will be guaranteed funding for an up to estimated 20,000+ additional staff by 2023/24:

• Clinical pharmacists (from 2019/20)• Social prescribing link workers (from 2019/20)• Physiotherapists (from 2020/21)• Physician associates (from 2020/21)• First contact community paramedics (from 2021/22).

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The Additional Roles Reimbursement scheme will meet a recurrent 70% of the costs of additional clinical pharmacists, physician associates, physiotherapists, and first contact community paramedics; and 100% of the costs of additional social prescribing link workers. By 2023/24, the reimbursement available to networks amounts to £891 million of new annual investment.

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Each Network will have a named accountable Clinical Director – they will play a critical role in shaping and supporting their Integrated Care System and dissolving the historic divide between primary and community care. Each Network will receive an additional ongoing entitlement to the equivalent of 0.25 WTE funding per 50,000 populationsize to contribute to the costs of this role. This equates to £2.01/head in 2019/20

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New Workforce“£4.5 billion of new investment will fund expanded community multidisciplinary teams aligned with new primary care networks based on neighbouring GP practices” NHS Long Term Plan